Individual
CARLY MANSHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
1340 S DAMEN AVE, CHICAGO, IL 60608-1169
(773) 680-2275
Mailing address
31 E OGDEN AVE UNIT 337, LA GRANGE, IL 60525-2132
(773) 680-2275
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
04/21/2025
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